Can video mobile phones improve CPR quality when used for dispatcher assistance during simulated cardiac arrest?

Denne artikkelen er en del av doktorgradsavhandlingen til Stein Roar Bolle. Avhandlingen finnes i Munin http://hdl.handle.net/10037/3597Background: Because mobile telephones may support video calls, emergency medical dispatchers may now connect visually with bystanders during pre-hospital cardiopulmonary resuscitation (CPR). We studied the quality of simulated dispatcher-assisted CPR when guidance was delivered to rescuers by video calls or audio calls from mobile phones. Methods: One hundred and eighty high school students were randomly assigned in groups of three to communicate via video calls or audio calls with experienced nurse dispatchers at a Hospital Emergency Medical Dispatch Center. CPR was performed on a recording resuscitation manikin during simulated cardiac arrest. Quality of CPR and time factors were compared depending on the type of communication used. Results: The median CPR time without chest compression (‘hands-off time’) was shorter in the video-call group vs. the audio-call group (303 vs. 331 s; P50.048), but the median time to first compression was not shorter (104 vs. 102 s; P50.29). The median time to first ventilation was insignificantly shorter in the video-call group (176 vs. 205 s; P50.16). This group also had a slightly higher proportion of ventiliations without error (0.11 vs. 0.06; P50.30). Conclusion: Video communication is unlikely to improve telephone CPR (t-CPR) significantly without proper training of dispatchers and when using dispatch protocols written for audio-only calls. Improved dispatch procedures and training for handling video calls require further investigation

Rubber agroforestry in Thailand provides some biodiversity benefits without reducing yields

Monocultural rubber plantations have replaced tropical forest, causing biodiversity loss. While protecting intact or semi‐intact biodiverse forest is paramount, improving biodiversity value within the 11.4 million hectares of existing rubber plantations could offer important conservation benefits, if yields are also maintained. Some farmers practice agroforestry with high‐yielding clonal rubber varieties to increase and diversify incomes. Here, we ask whether such rubber agroforestry improves biodiversity value or affects rubber yields relative to monoculture. We surveyed birds, fruit‐feeding butterflies and reptiles in 25 monocultural and 39 agroforest smallholder rubber plots in Thailand, the world's biggest rubber producer. Management and vegetation structure data were collected from each plot, and landscape composition around plots was quantified. Rubber yield data were collected for a separate set of 34 monocultural and 47 agroforest rubber plots in the same region. Reported rubber yields did not differ between agroforests and monocultures, meaning adoption of agroforestry in this context should not increase land demand for natural rubber. Butterfly richness was greater in agroforests, where richness increased with greater natural forest extent in the landscape. Bird and reptile richness were similar between agroforests and monocultures, but bird richness increased with the height of herbaceous vegetation inside rubber plots. Species composition of butterflies differed between agroforests and monocultures, and in response to natural forest extent, while bird composition was influenced by herbaceous vegetation height within plots, the density of non‐rubber trees within plots (representing agroforestry complexity) and natural forest extent in the landscape. Reptile composition was influenced by canopy cover and open habitat extent in the landscape. Conservation priority and forest‐dependent birds were not supported within rubber. Synthesis and applications. Rubber agroforestry using clonal varieties provides modest biodiversity benefits relative to monocultures, without compromising yields. Agroforests may also generate ecosystem service and livelihood benefits. Management of monocultural rubber production to increase inter‐row vegetation height and complexity may further benefit biodiversity. However, biodiversity losses from encroachment of rubber onto forests will not be offset by rubber agroforestry or rubber plot management. This evidence is important for developing guidelines around biodiversity‐friendly rubber and sustainable supply chains, and for farmers interested in diversifying rubber production

Nicotinic acetylcholine receptor β2 subunit gene implicated in a systems-based candidate gene study of smoking cessation

Although the efficacy of pharmacotherapy for tobacco dependence has been previously demonstrated, there is substantial variability among individuals in treatment response. We performed a systems-based candidate gene study of 1295 single nucleotide polymorphisms (SNPs) in 58 genes within the neuronal nicotinic receptor and dopamine systems to investigate their role in smoking cessation in a bupropion placebo-controlled randomized clinical trial. Putative functional variants were supplemented with tagSNPs within each gene. We used global tests of main effects and treatment interactions, adjusting the P-values for multiple correlated tests. An SNP (rs2072661) in the 3′ UTR region of the β2 nicotinic acetylcholine receptor subunit (CHRNB2) has an impact on abstinence rates at the end of treatment (adjusted P = 0.01) and after a 6-month follow-up period (adjusted P = 0.0002). This latter P-value is also significant with adjustment for the number of genes tested. Independent of treatment at 6-month follow-up, individuals carrying the minor allele have substantially decreased the odds of quitting (OR = 0.31; 95% CI 0.18–0.55). Effect of estimates indicate that the treatment is more effective for individuals with the wild-type (OR = 2.14, 95% CI 1.20–3.81) compared with individuals carrying the minor allele (OR = 0.83, 95% CI 0.32–2.19), although this difference is only suggestive (P = 0.10). Furthermore, this SNP demonstrated a role in the time to relapse (P = 0.0002) and an impact on withdrawal symptoms at target quit date (TQD) (P = 0.0009). Overall, while our results indicate strong evidence for CHRNB2 in ability to quit smoking, these results require replication in an independent sample

Patients in long-term maintenance therapy for drug use in Italy: analysis of some parameters of social integration and serological status for infectious diseases in a cohort of 1091 patients

BACKGROUND: Heroin addiction often severely disrupts normal social functioning. The aims of this multi-centre study of heroin users in long-term replacement treatment were: i) to provide information on aspects of social condition such as employment, educational background, living status, partner status and any history of drug addiction for partners, comparing these data with that of the general population; ii) to assess the prevalence of hepatitis, syphilis and HIV, because serological status could be a reflection of the social conditions of patients undergoing replacement treatment for drug addiction; iii) to analyse possible relationships between social conditions and serological status. METHODS: A cross-sectional study was carried out in sixteen National Health Service Drug Addiction Units in northern Italy. The data were collected from February 1, 2002 to August 31, 2002. Recruitment eligibility was: maintenance treatment with methadone or buprenorphine, treatment for the previous six months, and at least 18 years of age. In the centres involved in the study no specific criteria or regulations were established concerning the duration of replacement therapy. Participants underwent a face-to-face interview. RESULTS: The conditions of 1091 drug treatment patients were evaluated. The mean duration of drug use was 14.5 years. Duration was shorter in females, in subjects with a higher educational background, and in stable relationships. Most (68%) had completed middle school (11–14 years of age). Seventy-nine percent were employed and 16% were unemployed. Fifty percent lived with their parents, 34% with a partner and 14% alone. Males lived more frequently with their parents (55%), and females more frequently with a partner (60%). Sixty-seven percent of male patients with a stable relationship had a partner who had never used heroin. HCV prevalence was 72%, HBV antibodies were detected in 42% of patients, while 30% had been vaccinated; 12.5% of subjects were HIV positive and 1.5% were positive for TPHA. CONCLUSION: A significant percentage of heroin users in treatment for opiate addiction in the cohort study have characteristics which indicate reasonable integration within broader society. We posit that the combination of effective treatment and a setting of economic prosperity may enhance the social integration of patients with a history of heroin use